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Hoshi K, Imoto K, Yanagisawa Y, Nogami S, Unuma H, Yamauchi K. Periosteal expansion osteogenesis using a tubular dynamic frame device: An experimental study in rats. J Biomed Mater Res B Appl Biomater 2024; 112:e35471. [PMID: 39177324 DOI: 10.1002/jbm.b.35471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/13/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024]
Abstract
Periosteal expansion osteogenesis (PEO) is a technique for augmenting bone by creating a gradual separation between the bone and periosteum. This study assessed PEO-induced bone formation around the femurs of rats using a dynamic frame device (DFD), consisting of a shape memory membrane made of polyethylene terephthalate (PET) formed into a tubular shape. The DFDs, consisting of a PET membrane coated with hydroxyapatite (HA)/gelatin on the bone-contact surface, were inserted between the periosteum and bone of the femurs of rats. In the experimental group, DFDs were suture-fixed to the femur with 4-0 Vicryl Rapid; in the control group, 4-0 silk thread was used for fixation. Five rats per group were euthanized at intervals of 3, 5, and 8 weeks postoperatively. Bone formation was evaluated via micro-CT imaging, histomorphometry, and histological analysis. Morphological analysis revealed new bone between the femur and the periosteum, expanded by the DFD, in all groups. The mean values of new bone were 0.30 mm2 proximally, 0.18 mm2 centrally, and 0.82 mm2 distally in the control group, compared to 1.05 mm2 proximally, 0.27 mm2 centrally, and 0.84 mm2 distally in the experimental group. A significant difference in new bone was observed in the proximal region of the experimental group. Histological examination showed that a single layer of newly formed neoplastic bone was noted on the cortical bone surface across all sites. The proximal portion displayed a bone marrow cavity at the center, encircled by a thick bone cortex with a layered structure. New bone formation was notable between existing cortical bone and the periosteum, particularly at both ends of the DFD. The use of PET in PEO was a viable option for achieving ideal bone morphology.
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Affiliation(s)
- Karen Hoshi
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Division of Oral and Maxillofacial Reconstructive Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kazuhiro Imoto
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Division of Oral and Maxillofacial Reconstructive Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yuta Yanagisawa
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Division of Oral and Maxillofacial Reconstructive Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Division of Oral and Maxillofacial Reconstructive Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Hidero Unuma
- Graduate School of Science and Engineering, Yamagata University, Yonezawa, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Division of Oral and Maxillofacial Reconstructive Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Madi M. Induced osteogenesis using biodegradable and titanium periosteal distractors. Saudi Dent J 2021; 33:434-440. [PMID: 34803283 PMCID: PMC8589570 DOI: 10.1016/j.sdentj.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/28/2020] [Accepted: 12/22/2020] [Indexed: 10/31/2022] Open
Abstract
Background New bone formation can result from periosteal distraction. This is achieved through progressive uplifting of the periosteum by increasing the interface between it and the bone surface. Objective This study investigated the impact of gradual periosteal distraction using biodegradable materials and titanium distraction devices. Materials and methods 20 rabbits were separated into 2 groups. Distraction devices were placed in all groups after reflecting the calvarial periosteum. The device was actuated following 7 days. Group 1 got titanium device and Hydroxyapatite HA with poly-l-lactide (PLLA) device was utilized in group 2. Five animals were sacrificed from each group following 4 and 6 weeks. Newly formed bone was histologically and radiographically assessed. Results The histological observations showed that both distraction devices successfully induced osteogenesis and effectively distracted the soft tissue following 4 and six weeks. The study showed scattered bone trabeculae, with adipose tissue and multiple dome-shaped bones. Micro-computed tomography showed newly formed bone that was far less radiopaque than the initial basal bone. The connective tissue appeared as a radiolucent area that decreased gradually toward the fixation point of the device. At 6 weeks, the percentage of new bone was significantly higher than at 4 weeks for both devices. The PLLA device showed more bone than did the titanium device at both 4 and 6 weeks, but no significant difference was observed. Conclusions Both distraction devices were effective in distracting the periosteum and inducing new vascularized bone. The PLLA device induced more bone than the titanium device. Thus, the distractor composition may influence the new bone.
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Affiliation(s)
- Marwa Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Implant survival after graftless sinus floor augmentation in highly atrophic maxillae: a randomized controlled trial in a split mouth study. Int J Implant Dent 2021; 7:107. [PMID: 34661774 PMCID: PMC8523734 DOI: 10.1186/s40729-021-00387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The success rate of dental implants after graftless sinus augmentation versus conventional sinus augmentation surgery in atrophic maxillae in edentulous patients was investigated. METHODS This randomized study was performed in ten edentulous patients with marked maxillary atrophy. On the graftless side, the sinus membrane was lifted by a resorbable membrane. The control side was augmented with a mixture of autografts and xenografts. Implant placement followed 6 months postoperatively. Outcomes were implant survival, success of prosthetic rehabilitation and stability of vertical bone gain. RESULTS Ten patients were included. Postoperative radiology showed sufficient bone gain on both maxillary sides. Follow-up varied from 57 to 88 months. The conventional side showed significant (p = 0.041) more bone gain than the experimental side (respectively, 9.69 mm and 6.20 mm). A total of 59 implants were placed: 30 after conventional, 29 after graftless augmentation. One implant was lost on the conventional side and four on the experimental side. The implant survival was significantly higher on the conventional side (96.7% vs. 86.2%, p < 0.001, RR = 4.14). Prosthetic restoration was functionally successful in all cases. CONCLUSION Bone gain and implant survival were significantly lower in the non-grafted side versus the grafted side. Prosthetic rehabilitation was possible in all ten patients. The non-grafted technique may have some potential for clinical use, although it showed poorer results. Trial registration The Netherlands Trialregister. NTR NL3541 (NTR3696). Registered 20 January 2013, https://www.trialregister.nl/trial/3541 .
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He Z, Liu Y, Liu X, Sun Y, Zhao Q, Liu L, Zhu Z, Luo E. Smart Porous Scaffold Promotes Peri-Implant Osteogenesis under the Periosteum. ACS Biomater Sci Eng 2020; 6:6321-6330. [PMID: 33449673 DOI: 10.1021/acsbiomaterials.0c00956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Adequate peri-implant bone mass and bone quality are essential factors to ensure the initial stability of the implant and success of implant operation. In clinical settings, the lack of bone mass often restricts the implant operation. In this study, we fabricated a smart porous scaffold with a shape memory function and investigated whether it could promote peri-implant osteogenesis under the periosteum. Methods: A porous shape memory polymer (SMP) scaffold was fabricated and its shape memory function, mechanical properties, and degradation rate were tested in vitro. Moreover, the scaffold was implanted in the mandible of rabbits to evaluate its efficacy to promote peri-implant osteogenesis in the periosteum and enhance the initial stability of the implant. Histological, micro-CT, and biomechanical analyses were carried out for further verification. Results: The SMP scaffold has a good shape memory function and biocompatibility in vitro. In vivo experiments demonstrated that the SMP scaffold could recover to its original shape after implantation to create a small gap in the periosteum. After 12 weeks, the scaffold was gradually replaced by a newly formed bone, and the stability of the implant increased when it implanted with the scaffold. Conclusion: The present study indicates that the SMP scaffolds have a good shape memory function and could enhance peri-implant bone formation under the periosteum. The SMP scaffold provides a clinical potential candidate for bone tissue engineering under the periosteum.
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Affiliation(s)
- Ze He
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yao Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Xian Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Yue Sun
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Qiucheng Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Linan Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - Zhaokun Zhu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
| | - En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China
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Three-Dimensional-Printed Poly-L-Lactic Acid Scaffolds with Different Pore Sizes Influence Periosteal Distraction Osteogenesis of a Rabbit Skull. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7381391. [PMID: 32382570 PMCID: PMC7196141 DOI: 10.1155/2020/7381391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/29/2020] [Accepted: 03/17/2020] [Indexed: 12/25/2022]
Abstract
The repair of bone defects is a big challenge in reconstructive surgery. Periosteal distraction osteogenesis (PDO), as a promising technique used for bone regeneration, forms a space between the periosteum and bone cortex to regenerate the new bone merely by distracting the periosteum. In order to investigate the influence of distractor framework on the PDO, we utilized three-dimensional (3D) printing technology to fabricate three kinds of poly-L-lactic acid (PLLA) scaffolds with different pore sizes in this study. The in vitro experiments showed that the customized PLLA scaffolds had different-sized microchannels with low toxicity, good biocompatibility, and enough mechanical strength. Then, we built up an in vivo bioreactor under the skull periosteum of New Zealand white rabbits. The distractors with different pore sizes all could satisfy the demand of periosteal distraction in the animal experiments. After 8 weeks of consolidation period, the quality and quantity of the newly formed bone were improved with the increasing pore sizes of the distractors. Moreover, the newly formed bone also displayed an increasing degree of vascularization. In conclusion, 3D printing technology could promote the innovation of PDO devices and fabricate optimized scaffolds with appropriate pore sizes, shapes, and structures. It would help us regenerate more functional tissue-engineered bone and provide new ideas for further clinical application of the PDO technique.
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Lan C, Xiang X, Chu S, Wei W, He X, Li J. Preparation, Characterization and Properties of nHAp/PPC Membrane. J HARD TISSUE BIOL 2018. [DOI: 10.2485/jhtb.27.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Chuanjian Lan
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling (School and Hospital of Stomatology, Jilin University)
| | - Xingchen Xiang
- Department of General Dentistry, School and Hospital of Stomatology, Jilin University
| | - Shunli Chu
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University
| | - Wei Wei
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University
| | - Xi He
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University
| | - Jiang Li
- Department of Prosthodontics, School and Hospital of Stomatology, Jilin University
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Lutz R, Sendlbeck C, Wahabzada H, Tudor C, Prechtl C, Schlegel KA. Periosteal elevation induces supracortical peri-implant bone formation. J Craniomaxillofac Surg 2017; 45:1170-1178. [PMID: 28606438 DOI: 10.1016/j.jcms.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/12/2017] [Accepted: 05/11/2017] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The aim of the study was to evaluate the possibility of supracortical peri-implant bone formation after periosteal elevation. MATERIALS AND METHODS Periosteal elevation with an elevation height of 5 or 10 mm was performed in an animal experiment with 24 female domestic pigs. For this purpose, four implants were inserted in the frontal bone of each animal. The implants protruded from the local bone by 5 or 10 mm. In the test groups, the periosteum was attached to the protruding implants. In the control groups, the implants were covered with biocompatible degradable periosteal-shielding devices. Each 8 animals were sacrificed after 20, 40 and 60 days. De novo bone formation was evaluated radiographically and histologically. RESULTS Bone formation rate was higher in the test groups compared to the control groups after 20, 40 and 60 days. After 40 and 60 days, a statistically significant higher (P < 0.01) bone formation rate was found for both elevation heights. The maximum height of the generated bone was statistically significantly higher (P < 0.01) in the test groups for both elevation heights, compared to the control groups for all time points investigated. CONCLUSION Periosteal elevation by dental implants is a treatment option for supracortical peri-implant bone formation.
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Affiliation(s)
- Rainer Lutz
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Med. Dr. Med. Dent. Dr. H.C. Friedrich Wilhelm Neukam), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstrasse 27, 91054, Erlangen, Germany.
| | - Christina Sendlbeck
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Med. Dr. Med. Dent. Dr. H.C. Friedrich Wilhelm Neukam), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Hommeira Wahabzada
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Med. Dr. Med. Dent. Dr. H.C. Friedrich Wilhelm Neukam), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Christian Tudor
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Med. Dr. Med. Dent. Dr. H.C. Friedrich Wilhelm Neukam), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Christopher Prechtl
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Med. Dr. Med. Dent. Dr. H.C. Friedrich Wilhelm Neukam), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Karl Andreas Schlegel
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Med. Dr. Med. Dent. Dr. H.C. Friedrich Wilhelm Neukam), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Östliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
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Nakahara K, Haga-Tsujimura M, Sawada K, Mottini M, Schaller B, Saulacic N. Periosteal distraction osteogenesis versus immediate periosteal elevation in a rat model: Histological and micro-CT analysis. J Craniomaxillofac Surg 2017; 45:620-627. [PMID: 28285922 DOI: 10.1016/j.jcms.2017.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/25/2016] [Accepted: 01/26/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of the present study was to compare periosteal distraction osteogenesis (PDO) to immediate periosteal elevation (IPE) in terms of de novo bone formation. MATERIAL AND METHODS Animals of PDO Group were subjected to a 7-day latency period and a 10-day distraction period. Distraction device in IPE Group were activated for 1 mm at placement. Both groups of animals were euthanized at 17, 31 and 45-day following surgery and the samples analyzed histologically and by micro-CT. Total gap region (TG) was divided in two subregions, less than 0.5 mm (LG) and over 0.5 mm of the gap height (HG). RESULTS Bone formation in PDO Group was observed in the distal region of the distraction gap, whereas in IPE Group proximally and distally from the distraction gap. Bone volume increased in both groups in LG, HG and TG (p < 0.001), while bone mineral density only in HG (p = 0.001). More new bone was observed in PDO than in IPE Group in HG (p = 0.017) and in TG (p < 0.001), without differences found in bone mineral density. CONCLUSIONS The function of immediately elevated periosteum is limited to the distance to the underlying bone. PDO may be successfully applied to maintain the osteogenic capacity of elevated periosteum.
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Affiliation(s)
- Ken Nakahara
- Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamauracho, Chuo-ku, Niigata 951-8580, Japan.
| | - Maiko Haga-Tsujimura
- Department of Histology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamauracho, Chuo-ku, Niigata 951-8580, Japan.
| | - Kosaku Sawada
- Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamauracho, Chuo-ku, Niigata 951-8580, Japan.
| | - Matthias Mottini
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, University of Bern, CH-3010 Bern, Switzerland.
| | - Benoit Schaller
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, University of Bern, CH-3010 Bern, Switzerland.
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, University of Bern, CH-3010 Bern, Switzerland.
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Periosteal Distraction Osteogenesis: An Effective Method for Bone Regeneration. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2075317. [PMID: 28078283 PMCID: PMC5203878 DOI: 10.1155/2016/2075317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/15/2016] [Indexed: 01/04/2023]
Abstract
The treatment of bone defects is challenging and controversial. As a new technology, periosteal distraction osteogenesis (PDO) uses the osteogenicity of periosteum, which creates an artificial space between the bone surface and periosteum to generate new bone by gradually expanding the periosteum with no need for corticotomy. Using the newly formed bone of PDO to treat bone defects is effective, which can not only avoid the occurrence of immune-related complications, but also solve the problem of insufficient donor. This review elucidates the availability of PDO in the aspects of mechanisms, devices, strategies, and measures. Moreover, we also focus on the future prospects of PDO and hope that PDO will be applied to the clinical treatment of bone defects in the future.
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